Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2002
Randomized Controlled Trial Clinical TrialCaudal neostigmine, bupivacaine, and their combination for postoperative pain management after hypospadias surgery in children.
In a randomized, double-blinded study, we examined the analgesic efficacy of caudal neostigmine, bupivacaine, or a mixture of both drugs in 60 children. After the induction of general anesthesia, children were allocated randomly into three groups (n = 20) to receive a caudal injection of either 0.25% bupivacaine 1 mL/kg, with or without neostigmine 2 micro g/kg, or neostigmine 2 micro g/kg in normal saline 1 mL/kg. Intraoperatively, children receiving caudal bupivacaine or a bupivacaine/neostigmine mixture maintained hemodynamic stability, required less inhaled anesthetics, and had a shorter recovery time compared with the caudal neostigmine alone. Postoperatively, the caudal bupivacaine/neostigmine mixture resulted in superior analgesia compared with the other two groups. Recovery to first rescue analgesic times were (mean +/- SD) 22.8 +/- 2.9 h, 8.1 +/- 5.9 h, and 5.2 +/- 2.1 h in the bupivacaine/neostigmine, bupivacaine, and neostigmine groups, respectively (P < 0.001). In addition, the bupivacaine and neostigmine groups received more doses of paracetamol than the bupivacaine/neostigmine group to maintain adequate analgesia in the first 24 postoperative h. Postoperative vomiting occurred in 25%, 10%, and 30% in the caudal bupivacaine/neostigmine, bupivacaine, and neostigmine groups, respectively (P < 0.01). We conclude that caudal neostigmine 2 micro g/kg provides postoperative analgesia comparable to caudal bupivacaine in children undergoing hypospadias repair surgery. ⋯ Caudal neostigmine 2 micro g/kg provides postoperative analgesia comparable to caudal bupivacaine in children undergoing hypospadias repair surgery. Co-administration of the two drugs is associated with extended postoperative analgesia and reduced need for supplementary analgesics.
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Anesthesia and analgesia · Nov 2002
Randomized Controlled Trial Comparative Study Clinical TrialA randomized, double-blinded comparison of thoracic epidural ropivacaine, ropivacaine/fentanyl, or bupivacaine/fentanyl for postthoracotomy analgesia.
Epidural ropivacaine has not been compared with bupivacaine for postthoracotomy analgesia. Eighty patients undergoing elective lung surgery were randomized in a double-blinded manner to receive one of three solutions for high thoracic epidural analgesia. A continuous epidural infusion of 0.1 mL. kg(-1). h(-1) of either 0.2% ropivacaine, 0.15% ropivacaine/fentanyl 5 micro g/mL, or 0.1% bupivacaine/fentanyl 5 micro g/mL was started at admission to the intensive care unit. We assessed pain scores (rest and spirometry), IV morphine consumption, spirometry, hand grip strength, PaCO(2), heart rate, blood pressure, respiratory rate, and side effects (sedation, nausea, vomiting, and pruritus) for 48 h. Thoracic epidural ropivacaine/fentanyl provided adequate pain relief similar to bupivacaine/fentanyl during the first 2 postoperative days after posterolateral thoracotomy. The use of plain 0.2% ropivacaine was associated with worse pain control during spirometry, larger consumption of IV morphine, and increased incidence of postoperative nausea and vomiting. Morphine requirements were larger in the ropivacaine group, with no differences between bupivacaine/fentanyl and ropivacaine/fentanyl groups. Patients in the ropivacaine group experienced more pain and performed worse in spirometry than patients who received epidural fentanyl. There was no significant difference in motor block. We conclude that epidural ropivacaine/fentanyl offers no clinical advantage compared with bupivacaine/fentanyl for postthoracotomy analgesia. ⋯ Thoracic epidural ropivacaine/fentanyl provided adequate pain relief and similar analgesia to bupivacaine/fentanyl during the first 2 postoperative days after posterolateral thoracotomy. Plain 0.2% ropivacaine was associated with worse pain control and an increased incidence of postoperative nausea and vomiting. We conclude that epidural ropivacaine/fentanyl offers no clinical advantage compared with bupivacaine/fentanyl for postthoracotomy analgesia.
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Anesthesia and analgesia · Nov 2002
Randomized Controlled Trial Clinical TrialEphedrine reduces the pain from propofol injection.
One hundred seventy-six patients (ASA physical status I or II) presenting for elective surgery were randomly allocated into six study groups to compare the incidence of propofol-induced pain after pretreatment with different doses of ephedrine as compared with lidocaine. Patients in Group P (n = 30) received saline placebo; patients in Group L (n = 30) received 2% lidocaine 40 mg; patients received ephedrine 30 microg/kg (Group E30, n = 28), 70 microg/kg (Group E70, n = 30), 110 microg/kg (Group E110, n = 30), and 150 microg/kg (Group E150, n = 28), respectively, followed 30 s later by propofol 2.5 mg/kg. A blinded anesthesiologist asked the patient to evaluate the pain score (verbal rating scale and face pain scale). The incidence and intensity of pain was less in the lidocaine and ephedrine groups than in the placebo group (P < 0.01). Before tracheal intubation, the arterial blood pressure was decreased in the P and L groups, and after intubation, hemodynamics were increased in the E110 and E150 groups, respectively (P < 0.05). We concluded that pretreatment with a small dose of ephedrine (30 and 70 microg/kg) reduced the incidence and intensity of propofol-induced pain with a lesser decrease in arterial blood pressure than from propofol alone in lidocaine pretreatment. ⋯ Propofol is a widely used IV anesthetic for the induction of anesthesia, but it often causes local pain when administered into peripheral veins. A small dose of ephedrine reduces the incidence and intensity of the pain without significant adverse hemodynamic effects during induction.
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Anesthesia and analgesia · Nov 2002
Randomized Controlled Trial Clinical TrialIntravenous regional anesthesia using prilocaine and neostigmine.
Neostigmine has been added to local anesthetics for central and peripheral nerve blocks resulting in prolonged, increased anesthesia and improved analgesia. We conducted this study to evaluate the effects of neostigmine when added to prilocaine for IV regional anesthesia (IVRA). Thirty patients undergoing hand surgery were randomly assigned to two groups to receive IVRA. The control group received 1 mL of saline plus 3 mg/kg of prilocaine diluted with saline to a total dose of 40 mL; the study group received 0.5 mg of neostigmine plus 3 mg/kg of prilocaine diluted with saline to a total dose of 40 mL. Sensory and motor block onset and recovery, anesthesia quality determined by an anesthesiologist, anesthesia quality determined by a surgeon, and dryness of the operative field were noted. Heart rate, mean arterial blood pressure, and oxygen saturation values were noted at 1, 5, 10, 20, and 40 min before surgery and after tourniquet release. Time to first analgesic requirement was also noted. Shortened sensory and motor block onset times, prolonged sensory and motor block recovery times, improved quality of anesthesia, and prolonged time to first analgesic requirement were found in the neostigmine group. We conclude that neostigmine as an adjunct to prilocaine improves quality of anesthesia and is beneficial in IVRA. ⋯ Neostigmine has been added to local anesthetics for central and peripheral nerve blocks. This study was conducted to evaluate the effects of neostigmine when added to prilocaine for IV regional anesthesia (IVRA). Neostigmine as an adjunct to prilocaine improves quality of anesthesia and is beneficial in IVRA.
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Anesthesia and analgesia · Nov 2002
Comparative StudyThe delivery rate accuracy of portable infusion pumps used for continuous regional analgesia.
Portable pumps used for local anesthetic infusion during continuous regional analgesia are gaining acceptance. These pumps are often used for ambulatory patients who are medically unsupervised throughout most of the infusion. However, the performance of these pumps, which infuse potentially toxic medication, has not been independently investigated. We investigated the flow rate accuracy, consistency, and profiles of various portable pumps often used for local anesthetic infusion during continuous regional analgesia. By using a computer/scale combination within a laboratory to record infusion rates, 6 pumps were tested with their flow regulators at expected (30 degrees-32 degrees C) and increased (34 degrees-36 degrees C) temperatures. Infusion rate accuracy differed significantly among the pumps, exhibiting flow rates within +/-15% of their expected rate for 18%-100% of their infusion duration. An increase in temperature also affected pumps to differing degrees, with infusion rates increasing from 0% to 25% for each model tested. These results suggest that factors such as flow rate accuracy and consistency, infusion profile, and temperature sensitivity should be considered when choosing and using a portable infusion pump for local anesthetic administration. ⋯ Portable pumps often used for local anesthetic infusion during continuous regional analgesia exhibit varying degrees of delivery rate accuracy and consistency. Furthermore, increases in temperature result in an increased infusion rate for various pumps investigated. These factors should be taken into consideration when choosing and using a portable infusion pump.